Structural risk analysis of a potential Ebola outbreak with respect to infrastructural aspects amid the current COVID-19 pandemic.

Due to the ease and increased volume of global interaction, it remains unclear whether the current coronavirus disease (COVID-19) pandemic will be a one-off event or whether the world is at risk of recurrent pandemics as a result of globalization. To address this important issue, the present study assessed the risk of a possible future Ebola pandemic. The risk profile of Hubei province in China was compared with that of the Democratic Republic of Congo (DRC) in terms of travel and infrastructure, since DRC is considered a major epicenter for Ebola outbreaks. Recurrence patterns of previous Ebola outbreaks were analyzed in a cumulative outbreak model. Internationally available data on air traffic, flight destinations, passenger numbers, population density, distribution and domestic traffic routes were all analyzed and compared between the DRC and Hubei province. DRC is a major epicenter for Ebola outbreaks, with 13 recorded outbreaks from 1976 until 2020. International airports at both Kinshasa, the capital city of the DRC and Wuhan, the capital city of Hubei province, are heavily frequented destinations and represent major transfer hubs on their respective continents. Volumes of flights to and from extracontinental destinations account for <25% of total flights at both airports with similar total international passenger volumes. However, the volume of domestic commuting by aviation is >30-fold higher at Hubei province compared with that of the DRC. This finding is also reflected by the higher population density and homogeneity in terms of population per square kilometer in Hubei. Following the analysis of decades of Ebola reports, it became evident that the DRC remains a hotspot for potential Ebola outbreaks in the future due to constantly recurrent local outbreaks. In terms of the international aviation network, numerous important similarities between Kinshasa and Hubei Province were observed as regards connectivity. The present comparative analysis extends beyond biological factors underlying Ebola and COVID-19 transmissions and confirms that the DRC, Kinshasa in particular, is not a remote location. Although internal commuting and population density may be lower in the DRC compared with those in Hubei province, integration into the international aviation network is similarly extensive. The international community must increase its focus and efforts in preventing another possible global pandemic commencing in Africa, and in particular the DRC.